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Hematopoiesis- Martin Flashcards

1
Q

Pluripotent stem cell becomes

A

Myeloid stem cell ——> (IFU-E —> proerythroblast) RBC, (CFU-Mega—>Megakatocyte) Platelet, (Monoblast) Monocytes
Lymphoid stem cell ——> B cell, T cell, NK cells

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2
Q

Myeloid stem cells give

A
  1. (IFU-E —> proerythroblast) RBC,
  2. (CFU-Mega—>Megakatocyte) Platelet,
  3. (Monoblast) Monocytes
  4. (Myeloblast) N, B, E
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3
Q

Hematopoiesis happens where

A
  1. Yolk sac
  2. Liver + Spleen
  3. BM
  4. All over many bones
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4
Q

Marrow stromal compartment

A

Endothelial - barrier
Adipocytes - energy
Stromal cells - structure
M - remove dead cells

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5
Q

BM young

A

55% red
25% fat marrow
20% Trabecular bone

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6
Q

BM looks like

A

Field of flowers

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7
Q

BM elderly

A

25% red
60% marrow fat
15% trabecular bone

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8
Q

BM elderly with osteoporosis

A

20% red
70% marrow fat
10% trabecular bone

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9
Q

Cellularity in BM

A

100-age = % cellularity

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10
Q

SCF

A

Stem cell factor

= fetal tissues and BM

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11
Q

IL3

A

Replication and growth hematopoietic progenitor cells (Myeloid cells)

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12
Q

IL6

A

—> Megakaryocytes and N production

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13
Q

IL2

A

T-cell growth

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14
Q

IL2 + IL6

A

B-cell growth

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15
Q

GM-CSF

A

Leukocytes and reticulocyte formation

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16
Q

G-CSF

A

Increase N during neutropenia

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17
Q

M- CSF

A

Increase monocytes and macrophages

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18
Q

EPO

A

Erythropoietin
Made in kidney
Formation of RBCs (TX for anemia)

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19
Q

TPO

A

Thrombopoietin
Made in liver
Megakaryocytes and platelet production

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20
Q

Steps in erythropoiesis

A
  1. Pronormoblast - pale, large central nucleus
  2. Basophils normoblast - bluish clumps
  3. Polychromatic normoblast - checker board nucleus
  4. Orthochromic normoblast - pink
  5. Polychromatic erythrocytes = reticulocyte (no nucleus)- blue ribosomes
  6. Erythrocytes
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21
Q

High reticulocyte

A

Anemia or some kind of trauma

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22
Q

Supravital dye

A

For RBCs to see ribosomes

Methylene blue

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23
Q

Granulopoiesis

A 
Chromatin condenses 
Lubulated nucleus 
Cells shrink 
Granules in cytoplasm 
= N, B, E (all myeloid stem)
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24
Q

Agranulopoiesis

A 
Heterochromatin content increases
X granules 
No lobululation nucleus 
Cells shrink 
= Lymphocytes (Lymphoid stem), Monocytes (myeloid stem)
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25
Steps for Granulocytic leukopoiesis for Neutrophil
1. Myeloblast : large cyto and nucleus, no granules 2. Promeylocyte : Azurophilic granules, 3. Myelocyte : slight intention in nucleus, smaller granules and many 4. Metamyelocyte : huge deep indentation in nucleus where Golgi is, many granules 5. Bands : horseshoe nucleus (if high = left shift) 6. Polymorphonuclear N : segmented N
26
Steps for Granulocytic leukopoiesis for Basophils and eosinophils
Same steps as N (B = dark granules) (E = red orange granules)
27
Neutrophils
Phagocytosis | Release anti microbial chemicals
28
Eosinophils
Phagocytosis | Anti parasitic and bactericidal activity
29
Basophils
Secrete histamines and heparin
30
Immature B and T cells
No granules | 1-2 nucleoli
31
Mature B cells and T cells
BM and Thymus
32
Plasma cells
Activated by B-cells (in spleen and LNs) | Help T-cells go back to BM
33
Platelet steps
1. Megakaryoblast : large kidney shaped nucleus 2. Megakaryocytes: multilobed nucleus, endomitosis (many divisions inside cell) 3. Platelets : have some granules
34
Anemia
Decreased RBC volume (low Hb)
35
Polycythemia
Increased RBC or HB
36
Thrombopenia | Thrombocythemia
Decreased platelets | Increased platelets
37
Leukopenia
Lowed WBCs
38
Leukocytosis
High WBCs
39
Lymphocytosis
High lymphocytes
40
Absolute
Means number of cells is low or high (not dependent on percent)
41
Mean corpuscular volume
MCV = average RBC volume
42
MCH
Mean corpuscular hemoglobin | average hemoglobin mass in RBC
43
MCHC
Concentration of hemoglobin in a given volume
44
RPI
Reticulocyte production index | Reticulocyte % based on RBC volume
45
Normal MCV Low MCV High MCV
80-100 : Nomocytic anemia Low : Microcytic anemia (RBC is smaller then lymphocytes) High : macrocytic anemia (RBC is bigger then lymphocytes)
46
How to measure MCH
Look at central pallor
47
MCH normal low and high
Normal central pallor : Normochronic = normal Hb in each RBC Hypochromic : high central pallor Hyperchromic : low central pallor
48
RPI increases when
When O2 demand increases = left shift
49
Normal WBC
4.8-10.8 | Higher Hct and Hb in males, since females have menstruation and lower body mass
50
HCT is what
Hb x 3 = Hct (+/- 3)
51
MCV increased seen in
B12 and Folate deficiency
52
MCV decrease is seen in
Thalassemia : Fe+3 deficiency
53
Anicocytosis
Variation in size : high RDW (RBC distribution width = many sizes of RBCs seen) LOW : low MCV, Fe deficiency HIGH : high MCV : B12, folate deficiency
54
Poikilocytosis | FYI on examples
Many RBC variation in shape seen Spherocyte no central pallor = hereditary spherocytosis Oval, ellipse = Fe def, megoloblastic, thalassemia Bite cells = G6PD def
55
FE deficiency anemia is going to show
1. Anisocytosis + Poikilocytosis 2. Microcytic : low MCV 3. Hypochromic : low MCHC + MCH 4. Increased RDW 5. Low Hct, and low RBCs
56
High reticulocyte index means | Low means
Large RBC destruction Low production of RBCs **** do this if you see normal MCV****
57
If you see Microcytic anemia what do you do
1. Serum iron level 2. Total Fe binding capacity (TIBC) 3. serum ferritin lever = to know the type of Microcytic anemia
58
FE deficiency vs thalassemia can be done how
Look at RDW (erythrocytes size distribution)
59
Marked erythrocytes hyperplasia is what
Low M:E ration (myeloid to erythroid) | RBC loss, high reticulocyte = erythroid hyperplasia in BM
60
Marked erythrocytes hyperplasia is seen in what
``` G6PD def Sickle cell B-thalassemia Hereditary sperocytosis Autoimmune hemolytic anemia ```
61
Sickle cell and spleen
Autoinfarction of spleen
62
Megaloblastic hyperplasia you see | Seen when
1. MCV high 2. hypersegmented N 3. Hypercellular BM = in B12 (vegetarian, gasterectomy) and folate (preg, alcohol) deficiency
63
Aplastic anemia
1. Hypocellular BM (low hematopoiesis ) 2. Low Reticulocyte index 3. Normal MCV EX : Pancytopenia of all cell lines (from chemo, drugs, autoimmune)
64
Metastatic carcinoma
BM replaced by metastatic tumor, leukemia 1. Normal MVC 2. Low RPI
65
Marrow replacement shows
Leukoerythroblastosis | Nucleates, teardrop RBCs, immature WBCs
66
Extramedullary hematopoiesis
Occurring in organs not in BM (spleen, liver, LN) | = can show abnormal hematopoiesis
67
Schistocytes are what and seen when
Fragmented RBCs = Microangiopathic hemolytic anemia = thrombocytopenia + anemia
68
Microangiopathic hemolytic anemia
Schistocytes seen 1. Thrombocytopenia 2. Anemia (DIC, TTP, HUS)
69
Bite cells and Heinz bodies are seen when
``` G6PD deficiency (seen with supravital stain) = oxidative stress from infection, drugs, foods) ```
70
Hereditary spherocytosis you see
All RBC have NO central pallor and are small | Microcytic hypochromic anemia
71
Sickle cell anemia you see
HbS causing sickle cells
72
Normal person CBC of WBCs
Higher N then Lymphocytes (unless child) | Higher T cells then B cells
73
Neutropenia causes what
Pyogenic acute Bacterial infection (staph and strep) = supperative infection - Tx with steroids
74
Left shift
Bacteria* Many band cells (immature N) Metamyelocyes can be seen in very severe infections = Toxic granulation ->> accelerated N maturation
75
Leukemoid reaction
High WBCs + high N, not due to leukemia , due to infection or drugs with HIGH IL6 - HIGH LAP (leukocyte alkaline phosphatase) - low blasts
76
High WBC how do you know I it is leukemia or infection
``` Measure LAP (high in infection) Measure blasts % (low in infection) ```
77
Chronic Myelogenous Leukemia (CML)
High WBC, high blasts myeloid + lymphoid, low LAP | Blasts keep increasing : chronic phase —> accelerated phase —> blast phase
78
Acute myeloid leukemia (AML)
Blasts accumulate myeloid only* Thrombocytopenia + anemia + neutropenia = Auer rods seen in blood smear
79
Inadequate granulopoieses
``` 1. Low granulocytic precursors = drugs, toxins 2. Suppressed hematopoietic stem cells = aplastic anemia = marrow replacement 3. Ineffective hematopoiesis = neutropenia (megaloblastic anemia) 4. Congenital neutropenia ```
80
High Destruction RBCs seen in
``` 1. Immunological mediated injury to N = autoimmune, Lupus 2. Splenomegaly: = portal HTN, mild neutropenia 3. Increased peripheral utilization : = overwhelming bacteria or fungal infection ```
81
EBV you see what in blood smear
Mononucleosis = atypical T-cells
82
Chronic Lymphocytic Leukemia (CLL)
Older adults LA, hepatosplenomegaly = lymphocytes HIGH
83
Acute lymphoblastic leukemia (ALL)
HIGH BAST lymphocytes cells Children Panocytopenia happens
84
To see if you have leukemia
Flow cytomety to see if all cells are colonal
85
Monocytosis is seen
Autoimmune | Atypical bacteria infections
86
Basophilic seen when
Rare and seen in some leukemia like CML
87
Eosinophilia seen when
Allergy, parasites
88
Thrombocytopenia SX
Mucocutaneous bleeding = due to low platelets 1. petechiae : small hemorrhagic spots in skin 2. Ecchymosis : bruising large <100K avoid organ surgery <50K surgical bleeding < 20K spontaneous bleeding
89
3 causes of thrombocytopenia
1. Increased platelet destruction 2. Decreased platelet production 3. Hyperspenism accumulates platelets

MOD Exam2 (8 decks)

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